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.•`�iU�N c <br /> _' - SAN`,f O A Q U I N Environmental Health Department <br /> /e <br /> W , �' —COUNTY— <br /> Greatness <br /> COUNTY Greatness grows here. (1 tJAA1 <br /> COTTAGE FOOD OPERATIONS (CFO) ?REGISTRATION/PERMITTING FORM VV RM1I`1, �?F 0 <br /> (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) �T�SFR t F Ty <br /> CFO Businessame: r <br /> ner Name:_ Date: <br /> CFO Physical Address: CFO City: CFO Zip: <br /> 7voa- Corn wa r i Dr csfyckh)n CT5�9 <br /> Website(If applicable): Telephone: <br /> 209 _5701L _90c9 4 <br /> 1. Categories: <br /> "Class A" (Direct Sales Only) $155 ❑ "Class B" (Direct& Indirect Sales)$310 <br /> 2. Prohibited Items: Initial if you agree to abide by the following: cM <br /> Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br /> foods that are defined as "non-potentially hazardous" are approved for preparation by a Cottage Food Operation. <br /> These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br /> cause of food-borne illness. <br /> 3. "Class A" Self Certification Checklist: <br /> Checklist completed ("Class A" CFOs Only) <br /> 4. Products: <br /> Please check the items you will be preparing and/or selling. <br /> (� Baked Goods ❑ Dried Pasta ❑ Honey ❑ Popcorn/ <br /> Popcorn Balls <br /> ❑ Candy ❑ Dry Baking Mixes ❑ Mustard ❑ Vinegar <br /> ❑ Churros ❑ Waffle Cones ❑ Dried Grain Mixes ❑ Fruit Butter" <br /> 0/Buttercream ❑ Buttercream E/Flat IcingGround <br /> Frosting/Icing'` Fondant/Gumpaste* ❑ Chocolate <br /> ❑ Dried Mole Paste ❑ Herb/Spice Blends ❑ Pizzeles ❑ Jams/Jellies"' <br /> Nut Mixes/Nut Fried or Baked <br /> ❑ Fruit Empanadas ❑ Fruit Tamales/Pies ❑ Butters ❑ Donuts and <br /> Waffles <br /> ❑ Granola/Cereals ❑ Seasoning Salt ❑ Trail Mix/Dried Fruit ❑ Dried Fruit <br /> Salted Marshmallows/ <br /> ❑ Cotton Candy ❑ Candied Apples ❑ Caramel/Fudge ❑ Marshmallow <br /> Bars <br /> ❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br />